Cocaine Use Disorder in German outpatient addiction care - A trend analysis

Cocaine is more readily available than ever in Europe, leading to rising consumption rates and an increasing demand for treatment of Cocaine Use Disorder (CoUD) in Germany. This study examines the impact of these trends on the outpatient addiction care setting in Germany by analyzing national trends in the demand for CoUD-related care and the sociodemographic characteristics of clients entering outpatient addiction care facilities (OACF) with a primary diagnosis of CoUD between 2001 and 2023.

Data were derived from the German Addiction Care Statistical Service (DSHS), which annually aggregates data from OACFs across Germany. Joinpoint regression analysis assessed trends in the demand for CoUD-related care, the proportion of first-time admissions, and sociodemographic variables (age, gender, education level, employment status). The trends for CoUD were compared to those of individuals entering care with another primary substance use disorder (SUD).

The proportion of CoUD-related care episodes increased significantly from 1.8 % in 2001 to 4.4 % in 2023 in relation to the entire caseload, and to 8.2 % among SUDs (2001: 1.9 %). During this period, the CoUD client population became older, more educated (high education level: 4.7 % in 2001 vs. 23.4 % in 2023), and more frequently employed (33.6 % in 2009 vs. 53.7 % in 2023). The proportion of women remained relatively stable, with a slight increase from 12.9 % in 2001 to 13.5 % in 2023. First-time admissions for CoUD decreased overall but showed a significant increase from 2012 onward (2012: 35.9 %, 2023: 40.3 %).

CoUD is becoming increasingly relevant within German OACFs, with the care-seeking population shifting towards a profile characterized by middle age, higher education, and employment. In consequence, pre-existing programs for the care and support of individuals with CoUD may need to be adapted to enhance treatment success. Early interventions in occupational and educational settings may offer a promising approach. As our results seem to predominantly reflect CoUD caused by problematic powder cocaine use, more attention should also be given to individuals with problematic crack cocaine use, whose treatment needs and sociodemographic characteristics may differ.